RESUMEN
This article describes the development, implementation, and evaluation of a curriculum project designed to prepare medical students to care for populations who have Medicaid or a low socioeconomic status (SES). The setting for the project was a community-based medical school, the College of Human Medicine (CHM) at Michigan State University. This article describes a four-year process of curriculum development and offers examples of specific changes that CHM made to courses and clerkships. CHM modified 25% of preclinical courses, five core clerkships of year three, and two clerkships (Senior Surgery and Senior Internal Medicine) of year four. The authors describe highlights of outcomes in student performance, course and clerkship ratings, attitudes, professional goals, student self-assessment of their skills, and feedback from residency program directors. The authors identified four items on the Association of American Medical Colleges (AAMC) Graduation Questionnaire as related to the project and tracked them as an outcome measure of student attitudes related to the social responsibility of physicians. Attitudes of the students who experienced the modified curriculum showed greater agreement with AAMC Graduation Questionnaire items than the previous class at CHM and than their classmates across the country. The majority of residency program directors rated CHM graduates as more skilled than their peers in applying cultural competence, working with patients who have Medicaid or a low SES, and using community resources. The authors discuss factors that contributed to the successful implementation of curricular changes as well as challenges to their implementation.
Asunto(s)
Curriculum , Educación de Postgrado en Medicina/normas , Educación de Pregrado en Medicina/normas , Programas de Gobierno , Programas Nacionales de Salud , Facultades de Medicina , Estudiantes de Medicina , Accesibilidad a los Servicios de Salud , Humanos , Michigan , Pobreza , Responsabilidad Social , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
BACKGROUND AND OBJECTIVES: Future physicians are urged to balance effectiveness and cost in their prescribing of medications. This study determined whether educational sessions for residents together with a "Resident Report Card" changed residents' prescribing of generic medications in both commercial and Medicaid patient panels, compared with regional performance of physicians in practice in the community. METHODS: Twenty-four family medicine residents providing care for 1,038 (600 Medicaid and 438 commercial) members (or 31,140 total member months) received biannual profiles of their prescribing patterns and participated in four training sessions related to prescription profiling within a regional health plan. We monitored prescribing during two time periods and compared rates of generic prescribing to a baseline rate. RESULTS: Resident generic prescribing increased significantly for commercial members, from a base period (July 1, 2000-June 30, 2001) rate of 38.4% to a period 1 (July 1, 2001-June 30, 2002) rate of 38.0% and a period 2 (July 1, 2002-December 31, 2002) rate of 47.9%. It also increased for Medicaid members, from a base period rate of 47.8% to a period 1 rate of 49.1% and a period 2 rate of 52.6%. There was no similar change in regional prescribing performance during the same periods for physicians in practice in the community. CONCLUSIONS: Feedback systems and training based on actual health plan data can be developed for residency training on prescribing performance, resulting in improved cost-efficient prescribing patterns.